Pediatric and Geriatric Pharmacology — MCQs

Pediatric and Geriatric Pharmacology Indian Medical PG Practice Questions and MCQs

Question 61: What are the side effects of diethylstilbestrol when used in a pregnant woman?

A. Deep vein thrombosis in pregnant woman
B. Feminization of external genitalia of male offspring
C. Virilization of the external genitalia of female offspring
D. Infertility and development of vaginal carcinoma in female offspring (Correct Answer)

Explanation: ***Infertility and development of vaginal carcinoma in female offspring*** - Exposure to **diethylstilbestrol (DES)** *in utero* significantly increases the risk of developing **clear cell adenocarcinoma of the vagina** and **cervix** in female offspring. - Female offspring may also experience **structural abnormalities** of the reproductive tract and **infertility** due to DES exposure. *Deep vein thrombosis in pregnant woman* - While estrogens can increase the risk of **thromboembolic events**, the primary and well-documented long-term adverse effects of *in-utero* DES exposure relate specifically to the offspring's reproductive health, not acute maternal DVT. - DES was prescribed to prevent miscarriage, and its risks to the fetus were not fully understood at the time of its widespread use. *Feminization of external genitalia of male offspring* - **Diethylstilbestrol** is an **estrogen** and would not cause feminization of male genitalia; rather, *in-utero* exposure in males has been linked to an increased risk of **epididymal cysts**, **cryptorchidism**, and **hypogonadism**. - Feminization of male external genitalia is typically associated with **androgen deficiency** or **excess estrogen** from other sources or genetic conditions affecting sex differentiation. *Virilization of the external genitalia of female offspring* - **Virilization** in female offspring is caused by exposure to **excess androgens** *in utero*, as seen in conditions like **congenital adrenal hyperplasia** or maternal androgen-producing tumors. - **Diethylstilbestrol** is an estrogen and would not cause virilization; instead, it can lead to anatomical abnormalities of the female reproductive tract without masculinizing effects.

Question 62: All the following antihypertensive drugs are used in pregnancy except for one. Which one is contraindicated?

A. Nifedipine
B. Labetalol
C. Methyldopa
D. Enalapril (Correct Answer)

Explanation: ***Enalapril*** - **ACE inhibitors** like enalapril are absolutely contraindicated in pregnancy due to their association with **fetal renal dysfunction**, oligohydramnios, and **fetal death**. - They should be avoided throughout all trimesters, especially during the **second and third trimesters**. *Nifedipine* - **Nifedipine**, a calcium channel blocker, is considered a safe and effective antihypertensive agent during pregnancy. - It rapidly reduces blood pressure and is often used for acute management of **severe hypertension** in pregnancy, including pre-eclampsia. *Labetalol* - **Labetalol** is a combined alpha and beta-blocker that is a first-line treatment for hypertension in pregnancy. - It has a good safety profile for both the mother and the fetus, with extensive clinical experience supporting its use. *Methyldopa* - **Methyldopa** is one of the oldest and most studied antihypertensive drugs in pregnancy and is generally considered a first-line agent. - It acts centrally as an alpha-2 adrenergic agonist, reducing sympathetic outflow, and has shown good safety outcomes for long-term use.

Question 63: Which of the following is a safe drug for a nursing mother?

A. Chloramphenicol
B. Lithium
C. Amphetamines
D. Digoxin (Correct Answer)

Explanation: ***Digoxin*** - **Digoxin** is considered generally safe during lactation because it has a **low milk-to-plasma ratio** and is poorly absorbed orally by the infant. - The amount of digoxin transferred into breast milk is minimal and unlikely to cause clinically significant effects in the infant. *Chloramphenicol* - **Chloramphenicol** can cause severe adverse effects in infants, including **bone marrow suppression** and the **gray baby syndrome**, due to its ability to cross into breast milk. - Its use is contraindicated in nursing mothers due to these serious risks. *Lithium* - **Lithium** is excreted into breast milk and can reach therapeutic levels in the infant, potentially causing **lethargy**, **hypotonia**, **cyanosis**, and **cardiovascular adverse effects**. - Monitoring infant serum lithium levels is crucial if used, but it's generally advised against due to safety concerns. *Amphetamines* - **Amphetamines** are secreted into breast milk and can cause **irritability**, **poor feeding**, **sleep disturbances**, and even **seizures** in nursing infants. - Due to the high risk of central nervous system stimulation and other adverse effects, amphetamines are generally considered contraindicated during breastfeeding.

Question 64: Which of the following anticoagulants is the preferred choice for safe use in pregnancy?

A. Warfarin
B. Low molecular weight heparin (LMWH) (Correct Answer)
C. Unfractionated heparin (UFH)
D. Direct oral anticoagulants (DOACs)

Explanation: ***Low molecular weight heparin (LMWH)*** - **LMWH** does not cross the **placenta** and is the **preferred anticoagulant** for use throughout all trimesters of pregnancy. - It has a predictable anticoagulant response with **once or twice daily dosing** and does not require routine monitoring. - **Lower risk** of **heparin-induced thrombocytopenia (HIT)** and **osteoporosis** compared to unfractionated heparin. - **Longer half-life** allows for more convenient dosing and better patient compliance. *Warfarin* - **Warfarin** is a **teratogen** that crosses the placenta and can cause **fetal warfarin syndrome**, characterized by nasal hypoplasia, stippled epiphyses, and central nervous system abnormalities, particularly when used in the **first trimester** (6-12 weeks). - It also carries a high risk of **fetal bleeding**, especially in late pregnancy and during delivery. - **Contraindicated** in pregnancy except in very specific circumstances (e.g., mechanical heart valves where benefits may outweigh risks). *Unfractionated heparin (UFH)* - While **UFH** also does not cross the placenta and is considered **safe in pregnancy**, it is **less preferred** than LMWH. - Requires **frequent monitoring** of **activated partial thromboplastin time (aPTT)** due to unpredictable pharmacokinetics and variable bioavailability. - Long-term use associated with **higher risk** of **osteoporosis** and **heparin-induced thrombocytopenia (HIT)** compared to LMWH. - May be preferred over LMWH in specific situations: peripartum period (shorter half-life for easier reversal), severe renal impairment, or when immediate reversal with protamine may be needed. *Direct oral anticoagulants (DOACs)* - **DOACs** (rivaroxaban, apixaban, dabigatran, edoxaban) are **contraindicated** in pregnancy due to insufficient safety data. - Animal studies suggest potential for placental crossing and **teratogenic effects**. - Lack of reversal agents and concerns about **fetal bleeding** make them unsuitable for use in pregnancy.

Question 65: A newborn was given a drug in the neonatal ICU, but then was found in respiratory distress. The likely drug is?

A. Morphine (Correct Answer)
B. Naloxone
C. Salbutamol
D. Sodium bicarbonate

Explanation: ***Morphine*** - **Morphine** is an opioid that can cause **respiratory depression** as a significant side effect, especially in neonates who have immature metabolic pathways. - Neonates have a reduced capacity to metabolize and excrete opioids, leading to prolonged effects and a higher risk of **respiratory distress**. *Naloxone* - **Naloxone** is an opioid antagonist used to **reverse opioid overdose** and respiratory depression. - Administering naloxone would improve, not worsen, respiratory distress if it were opioid-induced. *Salbutamol* - **Salbutamol** is a beta-agonist used to **dilate airways** and treat bronchospasm, which would typically improve breathing. - It is not known to cause respiratory distress; rather, it's used to alleviate it in conditions like asthma or bronchiolitis. *Sodium bicarbonate* - **Sodium bicarbonate** is used to treat **metabolic acidosis**, which can sometimes be associated with respiratory issues but does not directly cause respiratory distress itself. - Its primary action is to buffer excess acid in the blood, and while it might impact respiratory drive indirectly, it is not a direct cause of respiratory depression.

Question 66: A pregnant lady in the third trimester is visiting a chloroquine-resistant malaria endemic area. Which drug is considered safe for her in terms of malaria prophylaxis?

A. Doxycycline
B. Atovaquone/Proguanil
C. Primaquine
D. Mefloquine (Correct Answer)

Explanation: ***Mefloquine*** - **Mefloquine** is generally considered safe for malaria prophylaxis in pregnant women, especially during the second and third trimesters. - It is an effective drug against **chloroquine-resistant malaria** and has good tolerability in this population. *Doxycycline* - **Doxycycline** is contraindicated in pregnancy, particularly during the second and third trimesters, due to its potential to cause **fetal skeletal and dental abnormalities**. - It can lead to permanent tooth discoloration and inhibit bone growth in the fetus. *Atovaquone/Proguanil* - **Atovaquone/Proguanil** is generally not recommended for malaria prophylaxis during pregnancy due to **limited safety data**. - While animal studies have not shown significant teratogenicity, its use is usually reserved for situations where other safer options are unavailable or unsuitable. *Primaquine* - **Primaquine** is contraindicated in pregnancy because it can cause **hemolytic anemia** in the fetus if the fetus has **glucose-6-phosphate dehydrogenase (G6PD) deficiency**. - Its use is specifically avoided in pregnancy to prevent this risk.

Question 67: The drug of choice for hyperthyroidism during the 2nd trimester of pregnancy is:

A. Propylthiouracil
B. Carbimazole (Correct Answer)
C. Sodium iodide
D. Radioactive iodine

Explanation: ***Carbimazole*** - **Carbimazole** is converted to **methimazole** in the body, which is generally preferred in the second and third trimesters due to a lower risk of serious liver toxicity compared to propylthiouracil. - While propylthiouracil is preferred in the first trimester, **methimazole/carbimazole** is considered safer in later trimesters after the period of major organogenesis. *Propylthiouracil* - **Propylthiouracil (PTU)** is the drug of choice for hyperthyroidism during the **first trimester** of pregnancy because of a lower risk of teratogenicity compared to methimazole/carbimazole. - However, **PTU** carries a risk of **hepatic toxicity** in the mother, making carbimazole/methimazole preferable in the second and third trimesters once the initial teratogenic risk largely passes. *Sodium iodide* - **Sodium iodide** is generally **contraindicated** in pregnancy for routine treatment of hyperthyroidism as it can cross the placenta and potentially cause **fetal goiter** and **hypothyroidism**. - Its use is typically limited to **thyroid storm** or preparation for thyroidectomy when other options are not suitable. *Radioactive iodine* - **Radioactive iodine (I-131)** is **absolutely contraindicated** during any trimester of pregnancy and lactation. - It rapidly crosses the placenta and can **ablate the fetal thyroid gland**, leading to permanent fetal hypothyroidism.

Question 68: A drug is more likely to cause toxicity in elderly patients due to all of the following reasons except which of the following?

A. decreased renal excretion of drugs
B. decreased hepatic metabolism
C. decreased volume of distribution (Correct Answer)
D. increased receptor sensitivity

Explanation: ***decreased volume of distribution*** - A **decreased volume of distribution** would generally lead to a higher peak plasma concentration for a given dose, potentially increasing drug effect and thus toxicity, particularly for **hydrophilic drugs**. - However, for drugs that primarily distribute into **fat** or have a large volume of distribution, age-related changes in body composition (e.g., increased body fat, decreased total body water) can actually lead to an **increased volume of distribution** for some lipophilic drugs. *decreased renal excretion of drugs* - **Aging** is associated with a decline in **glomerular filtration rate (GFR)** and **renal tubular function**, leading to reduced drug clearance. - This results in a longer **half-life** and accumulation of renally excreted drugs, increasing the risk of **toxicity**. *decreased hepatic metabolism* - Liver size, blood flow, and the activity of some **cytochrome P450 enzymes** may decrease with age. - This leads to reduced **first-pass metabolism** and slower systemic clearance of many hepatically metabolized drugs, increasing their **bioavailability** and plasma concentrations. *increased receptor sensitivity* - Elderly patients often exhibit altered **pharmacodynamic responses**, including **increased sensitivity** to certain drugs. - This means a lower concentration of the drug at the receptor site can produce a greater therapeutic or toxic effect, making them more susceptible to **adverse drug reactions**.

Question 69: A 75-year-old man with chronic kidney disease presents with worsening dyspnea and lower extremity edema. Which class of drugs should be used cautiously in this patient?

A. NSAIDs (Correct Answer)
B. Beta-blockers
C. Diuretics
D. ACE inhibitors

Explanation: ***NSAIDs*** - **NSAIDs** can cause **acute kidney injury** by inhibiting prostaglandin synthesis, which leads to **afferent arteriolar vasoconstriction** and reduced renal blood flow. This effect is exaggerated in patients with **pre-existing chronic kidney disease**. - They also can exacerbate **fluid retention** and worsen **edema** and symptoms of **heart failure**, which is particularly problematic in a patient with dyspnea and lower extremity edema. *ACE inhibitors* - While generally beneficial in CKD to slow progression, **ACE inhibitors** can cause **acute kidney injury** in patients with **renal artery stenosis** or severe volume depletion due to efferent arteriolar vasodilation. - They can also lead to **hyperkalemia**, which requires monitoring, but they are not contraindicated in this patient's presentation per se. *Beta-blockers* - **Beta-blockers** are often prescribed for cardiovascular conditions common in CKD patients, such as **hypertension** and **heart failure**, and are generally safe in CKD with appropriate dosing. - While some beta-blockers are renally excreted, their primary mechanism does not directly worsen kidney function or fluid retention in the same way NSAIDs do. *Diuretics* - **Diuretics** are essential in managing fluid overload, dyspnea, and edema in patients with **chronic kidney disease** and heart failure. - Although loop diuretics may be less effective with reduced kidney function and higher doses might be needed, they are not typically used cautiously; rather, they are a cornerstone of treatment for these symptoms.

Practice by Chapter

Developmental Pharmacology

Practice Questions

Pediatric Dosing Principles

Practice Questions

Neonatal Pharmacology

Practice Questions

Pharmacotherapy in Children

Practice Questions

Age-Related Changes in Pharmacokinetics

Practice Questions

Age-Related Changes in Pharmacodynamics

Practice Questions

Polypharmacy in the Elderly

Practice Questions

Medication Adherence in Elderly

Practice Questions

Inappropriate Prescribing in Elderly

Practice Questions

Deprescribing Principles

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free